新生儿窒息呼吸衰竭血浆内皮素-1和血栓素A_2及前列环素水平的临床研究

作者用放射免疫方法，测定了24例窒息后新生儿（其中呼吸衰竭9例）和33例正常新生儿的血浆ET－1和TXB2（TXA2的稳定代谢产物）及6－K－PGF1α（PGI2的稳定代谢产物）水平，并作动态观察。结果提示，分娩应激、尤其是窒息使新生儿血浆ET－1、TXA2和PGI2水平显著升高，随着缺氧情况改善，3种血管活性物质不同程度下降．ET－1与PGI2，TXA2与PGI2之间均处于动态平衡。血浆ET－1升高的幅度与呼吸衰竭的程度成正相关，ET－1在缺氧性肺血管收缩中可能起着重要作用。     

The Temporal Stage fallacy: A novel statistical fallacy in the medical literature

Celebrated for disproving the traditional view that lack of oxygen at birth (perinatal asphyxia) contributes significantly to cerebral palsy, a 1986 New England Journal of Medicine article by Karin Nelson and Jonas Ellenberg engineered a new consensus in the medical community: that lack of oxygen at birth rarely causes cerebral palsy. We demonstrate that the article's central argument relies on straightforwardly fallacious statistical reasoning, and we discuss significant implications -- e.g. how carefully fetuses are monitored during labor and delivery, expert testimony in malpractice cases, and public policy decisions.     

Antenatal antecedents of moderate or severe neonatal encephalopathy in term infants--a regional review

BACKGROUND: Regional audits of term infants with neonatal encephalopathy (NE) provide an opportunity to examine issues related to causation and quality of care. AIM: To document antenatal and intrapartum antecedents in a contemporary cohort of term infants with moderate or severe neonatal encephalopathy. METHODS: Term infants admitted with moderate-severe neonatal encephalopathy over 4 years were identified. The clinical records were reviewed for information about the pregnancy and birth including interpretation of monitoring and subsequent management of the labour and delivery. RESULTS: Fifty-two maternal records were reviewed. No mothers were diabetic or had gestations > 42 weeks, but 17% of the babies were small for gestational age (SGA). The cohort had evidence of antenatal hypoxia in 15%, a sentinel event in 25% and suboptimal fetal monitoring practice in at least 42% of cases. CONCLUSIONS: Peripartum events were the major contributors to neurological damage in infants with neonatal encephalopathy. Suboptimal fetal monitoring practice and sentinel events remain the most common contributors. Ongoing education and training to address these issues should be available to all involved with intrapartum care in New Zealand.     

Demographic characteristics and clinical course in infants with moderate or severe neonatal encephalopathy

A chart review of 64 infants with moderate or severe neonatal encephalopathy showed that resuscitation was required for 61 (95%), respiratory support for 53 (83%) and anticonvulsants for 58 (91%). Death occurred in 2 (4%) infants with moderate encephalopathy and 12 (86%) with severe encephalopathy. In addition, subsequent neurodevelopment was abnormal in approximately a quarter of infants who survived after a moderate to severe encephalopathy.     

13O例新生儿窒息的原因分析

目的从产科角度寻找新生儿窒息的原因,提出有效的预防措施,降低新生儿窒息发生率和死亡率,提高产科质量。方法对2006年1月-2008年1月在本院出生并发生新生儿窒息130例的相关因素进行回顾性分析。结果脐带因素、胎盘功能不全及羊水过少为主要原因分别占24．6％、23．1％、21．5％,重度窒息率以产前出血比率最高,占41．7％,其次为羊水过少、胎盘功能不全、早产。结论做好产前检查,及时治疗妊娠并发症,加强产前、产时胎心监护及B超检查,及时防治胎儿宫内窘迫。     

纳洛酮与氨茶碱联合治疗早产儿呼吸暂停疗效观察

目的观察纳洛酮与氨茶碱联合应用治疗早产儿呼吸暂停的临床效果。方法22例患儿随机分为两组,治疗组12例在应用纳洛酮的基础上加用氨茶碱,对照组10例单用氨茶碱,两组各用3-5d,观察两组的临床效果。结果纳洛酬与氨茶碱治疗组：显效7例,显效率58％（7／12）;有效4例,有效率33％（4／12）;总有效率92％（11／12）。氨茶碱对照组：显效4例,显效率40％（4／10）;有效3例,有效率30％（3／10）;总有效率70％（7／10）。纳洛酮与氨茶碱治疗组的总有效率显著高于氨茶碱对照组（P〈0．01）。结论氨茶碱和纳洛酮联合应用治疗早产儿呼吸暂停比单用氨茶碱效果好,值得临床推广。     

Available Bilirubin Binding Sites of Serum from Newborns Determined by a Direct Spectrometric Method Using Bromphenol Blue

A new direct spectrometric micromethod for the determination of the available bilirubin binding sites of serum (S-ABBS) using bromphenol blue has been applied to 298 blood specimens collected from infants immediately before starting the first exchange transfusion. A relative number fraction of 0.07 of the material, characterized by having the lowest S-ABBS values, includes seven of the nine cases (i. e. a relative number fraction of 0.78) with autoptically verified kernicterus (KI). The two infants with KI but higher S-ABBS values differed in having severe neurological symptoms before the examination. The mean substance concentration of bilirubin in these nine sera was 288 μmol/l. The correlation of KI to the body mass at birth, to the substance concentration of serum albumin, and to the substance concentration of serum bilirubin is given, and the sources of error concerning the method are discussed. The present method is proposed for determining a type of quantity that is important, among other types of data, in deciding on the need for exchange transfusion in icteric (premature) newborns.     

Neonatal herpes infections in The Netherlands in the period 2006–2011

Objective: To monitor the incidence of neonatal herpes in The Netherlands between 2006 and 2011, as well as the adherence to the rather conservative Dutch prevention policy.

Methods: Questionnaires were sent to all virology laboratories (n?=?44), gynaecology and paediatrics departments of all hospitals in The Netherlands (n?=?89). Questionnaires for the laboratories pertained to rates of proven cases of neonatal herpes; for the gynaecologists and paediatricians it pertained to rates of genital herpes during pregnancy and neonatal herpes, and their policy. For gynaecologists this concerned the risk of herpes simplex virus transmission in case of primary genital herpes during pregnancy or labour; for paediatricians it concerned the diagnostic policy in a neonate suspected of neonatal herpes.

Results: For the period 2006–2011 38 cases of neonatal herpes were reported, yielding an incidence of 4.7 per 100?000 births. The estimated annual number of pregnant women with primary or recurrent genital herpes was 278. Of the responding gynaecologists and paediatricians, only 59% and up to 39%, respectively, reported a policy in accordance with the national guideline.

Conclusions: The incidence of neonatal herpes in The Netherlands seems to have increased in the period 2006–2011. Combined with suboptimal guideline adherence this warrants strategies to improve awareness and subsequent adherence.     

2014—2019年北京市早产儿出生状况及围生结局分析

目的探讨北京市早产儿出生情况、影响因素及围生结局。 方法选择2014年1月1日至2019年12月31日,于北京市医疗机构住院分娩,并上报北京市妇幼保健管理信息系统的79 173例早产儿为研究对象。其中,出生胎龄<28周的极早早产儿(EEPI)、出生胎龄≥28～ 32周的早期早产儿(EPI)、出生胎龄≥32～34周的中期早产儿(MPI)、出生胎龄≥35～37周的晚期早产儿(LPI)分别为1 021、7 858、9 102、61 192例。收集所有早产儿的家庭人口学信息(户籍所在地、性别及其父母年龄、文化程度、职业),出生胎龄、妊娠胎数,母亲孕期风险情况(风险高、低),以及早产儿围生结局等。采用χ²检验,对早产儿发生率,影响EEPI、EPI、MPI及LPI发生因素的单因素分析及围生儿结局进行分析。采用多因素非条件有序多分类logistic回归分析,对影响EEPI、EPI、MPI及LPI发生的因素进行分析。EEPI、EPI、MPI及LPI出生体重比较,采用单因素方差分析。本研究遵循的程序符合首都医科大学附属北京妇产医院伦理委员会制定的标准,经过该伦理委员会批准(审批文号：IEC-C-03-V04-FJ2)。 结果①本研究时段北京市早产儿总体发生率为5.68% (79 173/1 394 782);2014—2019年每年分别为4.55%(11 355/249 429)、4.56%(9 549/209 455)、6.67%(15 983/ 239 692)、5.56%(14 674/263 991)、6.45%(13 790/213 819)及6.33%(13 822/ 218 396),呈总体增高趋势,并且总体比较差异有统计学意义(χ²＝1 936.451,P<0.001);每年EEPI、EPI、MPI及LPI发生率,亦均呈上升趋势,差异亦均有统计学意义(χ²＝102.991、244.086、242.817、1 381.002,P<0.001)。②EEPI、EPI、MPI及LPI户籍所在地、母亲年龄、母亲文化程度、母亲孕期风险情况、父亲年龄、父亲文化程度和父亲职业构成比比较,差异均有统计学意义(P<0.05)。早产儿母亲孕期风险情况、父亲职业和文化程度,均为影响EEPI、EPI、MPI及LPI发生的独立危险因素,孕期低风险孕妇分娩更晚期的早产儿可能性,是孕期高风险者的1.049倍(OR＝1.049, 95%CI：1.001～1.100,P＝0.047);父亲职业为公务员、军人、国家企事业单位工作人员,以及民营企业、私有企业或个体户工作人员,其获得更晚期的早产儿可能性,分别是父亲职业为无业人员或学生人员的1.351倍(OR＝1.351, 95%CI：1.290～1.415,P<0.001)与1.293倍(OR＝1.293,95%CI：1.239～1.351,P<0.001);父亲文化程度为研究生及以上,其获得更晚期的早产儿可能性,是父亲文化程度为高中及以下者的1.084倍(OR＝1.084,95%CI：1.000～1.176,P＝0.049)。③男性、非北京市户籍、单胎妊娠早产儿的出生体重分别为(2 455.5±601.2) g、(2 420.1±605.9) g、(2 456.8±612.4) g,分别显著高于女性、北京市户籍、多胎妊娠早产儿的出生体重(2 347.5±593.3) g、(2 400.1±596.6) g、(2 223.8±504.2) g,并且差异均有统计学意义(t＝5.375、4.715、709.884, P＝0.020、0.030、<0.001)。本研究时段内各年出生早产儿的出生体重总体比较,差异有统计学意义(F＝19.912,P<0.001)。④本组79 173例早产儿的先天畸形、颅内出血、出生窒息、听力筛查异常、遗传代谢性疾病发生率分别为0.43%(343/79 173)、0.21%(167/79 173)、6.45%(5 105/ 79 173)、2.34%(1 809/77 236)与0.10%(78/79 173)。其中,EEPI、EPI、MPI及LPI的先天畸形、颅内出血、出生窒息发生率,以及新生儿听力筛查通过、未通过及未筛查构成比分别比较,差异均有统计学意义(χ²＝140.208、25.281、9 656.282、197.692,P<0.001)。 结论2014—2019年北京市早产儿发生率为5.67%,早产儿围生期结局与早产儿的家庭人口学信息密切相关。因此,针对早产儿家庭人口学信息的医疗干预及管理,可改善早产儿预后。     

8025例阴道分娩人群新旧产程管理下分娩及妊娠结局比较

目的:探讨新旧产程管理对妊娠结局的影响。方法:选择本院阴道分娩的低危初产妇分为新产程组(2014年10月-2015年3月,新产程管理,n=4146)和旧产程组(2013年10月-2014年3月,旧产程管理,n=3879)。评价两组第一、二、总产程时限、分娩方式、产时发热、分娩镇痛、产后出血率、会阴侧切、阴道助产、新生儿体重、新生儿窒息及新生儿入住新生儿重症监护室情况。结果:新产程组第一、第二产程及总产程时间均长于旧产程组,分娩镇痛率(38.5%)、新生儿体重(3391.5±377.7g)及产后出血率(10.9%)高于旧产程(26.4%、3372.6±372.1g和6.3%),会阴侧切率(25.1%)低于旧产程组(36.8%)(均P0.05);产时发热(6.5%)、阴道助产率(8.9%)、新生儿窒息(0.9%)以及新生儿入住重症监护室的发生率(8.4%)与旧产程组(6.2%、8.7%、1.2%及7.3%)无差异(P0.05)。结论:新产程管理下新生儿结局与旧产程未见差异,但尚不能完全证实对产后出血安全性。